Bottom Line:
Although this is not the thumbrule, there are exceptional reports too.As trauma favors infection, most lesions are on the foot and lower leg but they may occur anywhere on the body mimicking actinomycosis.However, lab investigations and culture are important tool to differentiate apart from the clinical picture.

ABSTRACTMycetoma is a chronic, granulomatous disease of the skin, and subcutaneous tissue, which sometimes involves muscle, bones, and neighboring organs. It is characterized by tumefaction, abscess formation, and fistulae with discharge of grains from sinuses. Mycetoma can be caused by various species of fungi (eumycetoma) and aerobic actinomycetes (actinomycetoma), which occur as saprophytes in soil or plants. A tentative diagnosis sufficient to initiate treatment may be made on the basis of grain color. For instance, melanoid grains are always caused by fungi and ochroid or pale grains by actinomycetes. Although this is not the thumbrule, there are exceptional reports too. As trauma favors infection, most lesions are on the foot and lower leg but they may occur anywhere on the body mimicking actinomycosis. However, lab investigations and culture are important tool to differentiate apart from the clinical picture. We are reporting atypical case with unusual site of presentation (perineum and thigh) of mycetoma.

Mentions:
A 36-year-old man, farmer by occupation, presented with 8-year history of nonhealing lesions on the thigh and genitals [Figure 1]. The condition started as a single painless nodule followed by development of multiple brownish papules and nodules in the surrounding area in about a year. The patient was otherwise healthy with negative surgical or medical history of any long-term illness other than this one. There was no history of any trauma at the site. On examination, there were many discharging sinuses simulating “water can” appearance of Lymphogranuloma venereum (LGV) discharging pus. On pressing, the dark melanotic granules were expressed out [Figure 2]. All routine investigations were performed along with biopsy, KOH mount of the granules, and the X-ray of the local part to judge the extent of the lesions. Chest X-ray was normal. MT was negative. S. HIV and S.VDRL were normal. Tentative diagnosis of deep granuloma was made.

Mentions:
A 36-year-old man, farmer by occupation, presented with 8-year history of nonhealing lesions on the thigh and genitals [Figure 1]. The condition started as a single painless nodule followed by development of multiple brownish papules and nodules in the surrounding area in about a year. The patient was otherwise healthy with negative surgical or medical history of any long-term illness other than this one. There was no history of any trauma at the site. On examination, there were many discharging sinuses simulating “water can” appearance of Lymphogranuloma venereum (LGV) discharging pus. On pressing, the dark melanotic granules were expressed out [Figure 2]. All routine investigations were performed along with biopsy, KOH mount of the granules, and the X-ray of the local part to judge the extent of the lesions. Chest X-ray was normal. MT was negative. S. HIV and S.VDRL were normal. Tentative diagnosis of deep granuloma was made.

Bottom Line:
Although this is not the thumbrule, there are exceptional reports too.As trauma favors infection, most lesions are on the foot and lower leg but they may occur anywhere on the body mimicking actinomycosis.However, lab investigations and culture are important tool to differentiate apart from the clinical picture.

ABSTRACTMycetoma is a chronic, granulomatous disease of the skin, and subcutaneous tissue, which sometimes involves muscle, bones, and neighboring organs. It is characterized by tumefaction, abscess formation, and fistulae with discharge of grains from sinuses. Mycetoma can be caused by various species of fungi (eumycetoma) and aerobic actinomycetes (actinomycetoma), which occur as saprophytes in soil or plants. A tentative diagnosis sufficient to initiate treatment may be made on the basis of grain color. For instance, melanoid grains are always caused by fungi and ochroid or pale grains by actinomycetes. Although this is not the thumbrule, there are exceptional reports too. As trauma favors infection, most lesions are on the foot and lower leg but they may occur anywhere on the body mimicking actinomycosis. However, lab investigations and culture are important tool to differentiate apart from the clinical picture. We are reporting atypical case with unusual site of presentation (perineum and thigh) of mycetoma.